ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2015-3-63-70ophthalmology-261Research ArticleКЛИНИЧЕСКИЕ И ЭКСПЕРИМЕНТАЛЬНЫЕ ИССЛЕДОВАНИЯCLINICAL & EXPERIMENTAL RESEARCHНовая система для определения стадии структурных изменений при первичной открытоугольной глаукоме на основе морфометрического анализа диска зрительного нерва при Гейдельбергской ретинальной томографии II (версия 3.1.2)New system for stage determination of the structural changes in primary open-angle glaucoma based on morphometric analysis of the optic disk performed by Heidelberg Retina Tomograph II (version 3.1.2)АнгеловБ.AnguelovB.dr.ananyto@yahoo.comТошевА.ToshevA.Кафедра офтальмологии, МУ-София, УМБАЛ «Александровская» София, Болгария, бул. «Св. Георги Софийски» 1, 1431 София, БългарияРоссияDepartment of Ophthalmology, Medical University-Sofia, University Hospital Alexandrovska, Sofia, Bulgaria, bul. St. George St. Sophia 1, 1431 Sofia, BulgariaRussian Federation2015011020151236370Copyright © Ангелов Б., Тошев А., 20152015Ангелов Б., Тошев А.Anguelov B., Toshev A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/261Цель

Цель: выявление корреляционной связи между общими и секторальными топографическими параметрами (ТП) диска зрительного нерва (ДЗН) и показателями стандартной автоматизированной периметрии; определение диагностической точности TП ДЗН; разработка системы для определения стадии структурных изменений при первичной открытоугольной глаукоме (ПОУГ) с использованием общих и секторальных ТП ДЗН при проведении Гейдельбергской ретинальной томографии (HRT) II.

Пациенты и методы

Пациенты и методы: обследовано 257 глаз 176 человек (средний возраст 64±11 лет), 69 мужчин (79 глаз) и 107 женщин (178 глаз). Пациенты были разделены на четыре группы: контрольную группу здоровых добровольцев и три группы пациентов с ПОУГ в зависимости от выраженности изменений в поле зрения (по классификации Hodapp-Parrish-Anderson). Было проведено полное офтальмологическое обследование глаз, стандартная компьютерная периметрия (SITA стандарт 30‑2), HRT II (3.1.2) с корреляционным и ROC анализом с использованием версии 17.0 статистического пакета SPSS.

Результаты

Результаты: из топографических параметров площадь нейроретинального пояска (НРП) (r = 0.469, r = –0.384) и объём НРП (r = 0.431, r = –0.363) в наибольшей степени коррелировали с изменениями поля зрения в отношении соответствующих периметрических индексов — MD и PSD ТП ДЗН. Наиболее высокой диагностической ценностью обладают: показатель экскавации (AUROC = 0.778), вертикальное отношение экскавация / ДЗН (AUROC = 0.721), отношение площади НРП / ДЗН (AUROC = 0.714), площадь НРП (AUROC = 0.711) и объём НРП (AUROC = 0.706). Разработана система определения стадии структурных изменений при ПОУГ на основе общих, секторальных и топографических параметров ДЗН, полученных в ходе исследования с помощью HRT II. Система включает в себя четыре различных этапа — ранний, умеренный, расширенный и терминальный, и каждый из них характеризуется интервалом величины выбранных ТП.

Выводы

Выводы: Изменения величины общих топографических параметров — площади и объемаНРП — в наибольшей степени обусловливают изменения ЗП при ПОУГ. Показатель, который отражает форму экскавации — cup shape measure, следует учитывать при ранней диагностике глаукомы. Предлагаемая комбинированная система классификации изменений при ПОУГ отражает одновременно степень и локализацию дефектов в ДЗН, а также наличие определенных признаков прогрессирования болезни. Возможности использования данной системы при оценке прогрессирования глаукомы определяются наличием стандартных критериев.

Purpose

Purpose: To determine the correlation between global and sectoral topographic parameters (TP) of the optic nerve head (ONH) and the standard automated perimetry common indices, to assessment of the diagnostic accuracy of the ONH TPs in primary open-angle glaucoma (POAG) discrimination; to establish a combined staging system of glaucomatous structural damage based on global and sectoral TPs of ONH obtained by Heidelberg Retina Tomograph (HRT) II.

Patientsand methods

Patientsand methods: 257 eyes of 176 patients (mean age 64±11), 69 (79 eyes) men and 107 (178 eyes) women were examined. They were separated in four groups: a control group of healthy volunteers and three groups of POAG patients with different severity of their visual field changes according to the Hodapp-Parrish-Anderson classification. Comprehensive ophthalmic examination, standard automated perimetry (SITA standard 30‑2) and examination with HRT II (3.1.2) were performed.

Results

Results: The TPs rim area (r = 0.469, r = –0.384) and rim volume (r = 0.431, r = –0.363) were most strongly correlated with the visual field changes expressed by the common indices — MD and PSD. The ONH TPs with highest diagnostic value were: cup shape measure (AUROC = 0.778), vertical cup / disc ratio (AUROC = 0.721), rim / disc area ratio (AUROC = 0.714), rim area (AUROC = 0.711) and rim volume (AUROC = 0.706). The staging system of glaucomatous structural damage based on global and sectoral TPs of ONH obtained by HRT II was established. It consists of four different stages: early, developed, advanced and terminal. Each of them is characterized by the interval of the chosen TP values.

Conclusion

Conclusion: The changes of TPs rim area and rim volume determine the highest level of visual field changes in POAG. Cup shape measure is the most important TP in early glaucoma diagnostics. The proposed combined glaucoma staging system presents both the degree and the localization of the ONH defects together with some disease progression risk factors. The presence of standardized criteria allows its use in glaucoma progression follow-up.

первичная открытоугольная глаукомаГейдельбергская ретинотомография IIтопографические параметрысистема стадированияprimary open-angle glaucomaHeidelberg Retina Tomograph IItopographic parametersstaging systemReferencesTraverso CE, Walt JG, Kelly SP, et al. Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe. Br J Ophthalmol 2005; 89:1245‑9.Traverso CE, Walt JG, Kelly SP, et al. Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe. Br J Ophthalmol 2005; 89:1245‑9.Bowd C, Zangwill LM, Medeiros FA, et al. Confocal scanning laser ophthalmoscopy classifiers and stereophotograph evaluation for prediction of visual field abnormalities in glaucoma-suspect eyes. Invest Ophthalmol Vis Sci 2004; 45 (7):2255‑62.Bowd C, Zangwill LM, Medeiros FA, et al. Confocal scanning laser ophthalmoscopy classifiers and stereophotograph evaluation for prediction of visual field abnormalities in glaucoma-suspect eyes. Invest Ophthalmol Vis Sci 2004; 45 (7):2255‑62.Feiner L, Piltz-Seymour JR. Collaborative Initial Glaucoma Treatment Study: a summary of results to date. Curr Opin Ophthalmol 2003; 14:106‑11.Feiner L, Piltz-Seymour JR. Collaborative Initial Glaucoma Treatment Study: a summary of results to date. Curr Opin Ophthalmol 2003; 14:106‑11.Spaeth GL, Lopes JF, Junk AK et al. Systems for staging the amount of optic nerve damage in glaucoma: a critical review and new material. Surv Ophthalmol 2006 Jul-Aug; 51 (4):293‑315.Spaeth GL, Lopes JF, Junk AK et al. Systems for staging the amount of optic nerve damage in glaucoma: a critical review and new material. Surv Ophthalmol 2006 Jul-Aug; 51 (4):293‑315.Ferreras A, Pablo LE, Pajarín AB, et al. Diagnostic ability of the Heidelberg Retina Tomograph 3 for glaucoma. Am J Ophthalmol 2008 Feb; 145 (2):354‑359.Ferreras A, Pablo LE, Pajarín AB, et al. Diagnostic ability of the Heidelberg Retina Tomograph 3 for glaucoma. Am J Ophthalmol 2008 Feb; 145 (2):354‑359.Iliev ME, Meyenberg A, Garweg JG. Morphometric assessment of normal, suspect and glaucomatous optic discs with Stratus OCT and HRT II. Eye (Lond) 2006 Nov; 20 (11):1288‑99.Iliev ME, Meyenberg A, Garweg JG. Morphometric assessment of normal, suspect and glaucomatous optic discs with Stratus OCT and HRT II. Eye (Lond) 2006 Nov; 20 (11):1288‑99.Kuroyedov AV, Golubev SYu, Shafranov GV. [Morphometric criteria optic nerve head and possibilities of modern laser diagnostics equipment]. Issledovanie morfometricheskih kriteriev diska zritel’nogo nerva v svete vozmozhnostej sovremennoj lazernoj diagnosticheskoj tehniki [Glaucoma] Glaukoma 2005; 2:7‑18. (in Russ.)Kuroyedov AV, Golubev SYu, Shafranov GV. [Morphometric criteria optic nerve head and possibilities of modern laser diagnostics equipment]. Issledovanie morfometricheskih kriteriev diska zritel’nogo nerva v svete vozmozhnostej sovremennoj lazernoj diagnosticheskoj tehniki [Glaucoma] Glaukoma 2005; 2:7‑18. (in Russ.)Machekhin VA, Fabrikantov OL. [Color topography of the pathologic parameters of the OD by means of the laser scanning retinotomograph HRT III]. Bulgarian Forum Glaucoma 2014; 4 (1):13‑21.Machekhin VA, Fabrikantov OL. [Color topography of the pathologic parameters of the OD by means of the laser scanning retinotomograph HRT III]. Bulgarian Forum Glaucoma 2014; 4 (1):13‑21.European Glaucoma Society. Terminology and Guidelines for Glaucoma. Savona, Italy, IIIrd Edn, 2008 (www.eugs.org).European Glaucoma Society. Terminology and Guidelines for Glaucoma. Savona, Italy, IIIrd Edn, 2008 (www.eugs.org).Zangwill LM, Weinreb RN, Beiser JA, et al. Baseline topographic optic disc easurements are associated with the development of primary open-angle glaucoma: the Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study. Arch Ophthalmol 2005 Sep; 123 (9):1188‑97.Zangwill LM, Weinreb RN, Beiser JA, et al. Baseline topographic optic disc easurements are associated with the development of primary open-angle glaucoma: the Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study. Arch Ophthalmol 2005 Sep; 123 (9):1188‑97.Hwang YH, Kim YY. Glaucoma Diagnostic Ability of Quadrant and Clock-Hour Neuroretinal Rim Assessment Using Cirrus HD Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2012; 53:2226‑34.Hwang YH, Kim YY. Glaucoma Diagnostic Ability of Quadrant and Clock-Hour Neuroretinal Rim Assessment Using Cirrus HD Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2012; 53:2226‑34.Larrosa JM, Polo V, Ferreras A, et al. Predictive value of confocal scanning laser for the onset of visual field loss in glaucoma suspects. Ophthalmology 2012 Aug; 119 (8):1558‑62.Larrosa JM, Polo V, Ferreras A, et al. Predictive value of confocal scanning laser for the onset of visual field loss in glaucoma suspects. Ophthalmology 2012 Aug; 119 (8):1558‑62.Leung CK, Liu S, Weinreb RN, et al. Evaluation of retinal nerve fiber layer progression in laucoma a prospective analysis with neuroretinal rim and visual field progression. Ophthalmology 2011; 118:1551‑7.Leung CK, Liu S, Weinreb RN, et al. Evaluation of retinal nerve fiber layer progression in laucoma a prospective analysis with neuroretinal rim and visual field progression. Ophthalmology 2011; 118:1551‑7.Weinreb RN, Zangwill LM, Jain S, et al., OHTS CSLO Ancillary Study Group. Predicting the onset of glaucoma: the confocal scanning laser ophthalmoscopy ancillary study to the Ocular Hypertension Treatment Study. Ophthalmology 2010 Sep; 117 (9):1674‑83.Weinreb RN, Zangwill LM, Jain S, et al., OHTS CSLO Ancillary Study Group. Predicting the onset of glaucoma: the confocal scanning laser ophthalmoscopy ancillary study to the Ocular Hypertension Treatment Study. Ophthalmology 2010 Sep; 117 (9):1674‑83.Armaly MF: The optic cup in the normal eye. I. Cup width, depth, vessel displacement, ocular tension and outflow facility. Am J Ophthalmol 1969; 68:401‑7.Armaly MF: The optic cup in the normal eye. I. Cup width, depth, vessel displacement, ocular tension and outflow facility. Am J Ophthalmol 1969; 68:401‑7.Schulz S, Mardin CY, Diller M, et al. Improvement of Glaucoma Classification based on HRT using a Multi Parameter Analysis and the Relationship to Spectralis RNFL Thickness Measurements. ARVO — abstracts 2011, Fort Lauderdale, Florida.Schulz S, Mardin CY, Diller M, et al. Improvement of Glaucoma Classification based on HRT using a Multi Parameter Analysis and the Relationship to Spectralis RNFL Thickness Measurements. ARVO — abstracts 2011, Fort Lauderdale, Florida.Jonas JB, Gusek GC, Naumann GO: Optic disc morphometry in chronic primary open-angle glaucoma. II. Correlation of the intrapapillary morphometric data to visual field indices. Graefes Arch Clin Exp Ophthalmol 1988; 226:531‑8.Jonas JB, Gusek GC, Naumann GO: Optic disc morphometry in chronic primary open-angle glaucoma. II. Correlation of the intrapapillary morphometric data to visual field indices. Graefes Arch Clin Exp Ophthalmol 1988; 226:531‑8.Richardson KT. Glaucoma and glaucoma suspects, In Richardson KT, eds. Glaucoma: Conceptions of a Disease, Pathogenesis, Diagnosis, Therapy. Philadelphia, WB Saunders, 1978, p 2‑6.Richardson KT. Glaucoma and glaucoma suspects, In Richardson KT, eds. Glaucoma: Conceptions of a Disease, Pathogenesis, Diagnosis, Therapy. Philadelphia, WB Saunders, 1978, p 2‑6.Nicolela MT, Drance SM. Various glaucomatous optic nerve head appearences: clinical correlations. Ophthalmology 1996; 103:640‑9.Nicolela MT, Drance SM. Various glaucomatous optic nerve head appearences: clinical correlations. Ophthalmology 1996; 103:640‑9.Omodaka K, Nakazawa T, Otomo T, et al. Correlation between morphology of optic disc determined by Heidelberg Retina Tomograph II and visual function in eyes with open-angle glaucoma. Clin Ophthalmol 2010; 4:765‑772.Omodaka K, Nakazawa T, Otomo T, et al. Correlation between morphology of optic disc determined by Heidelberg Retina Tomograph II and visual function in eyes with open-angle glaucoma. Clin Ophthalmol 2010; 4:765‑772.Brusini P, Zeppieri M, Tosoni C, et al. Optic disc damage staging system. J Glaucoma 2010; 19:442‑9.Brusini P, Zeppieri M, Tosoni C, et al. Optic disc damage staging system. J Glaucoma 2010; 19:442‑9.Spaeth GL, Henderer J, Steinmann W. The disc damage likelihood scale: its use in the diagnosis and management of glaucoma. Highlights Ophthalmol 2003;31:4‑16.Spaeth GL, Henderer J, Steinmann W. The disc damage likelihood scale: its use in the diagnosis and management of glaucoma. Highlights Ophthalmol 2003;31:4‑16.Cho BJ, Park KH. Topographic correlation between β-zone parapapillary atrophy and retinal nerve fiber layer defect. Ophthalmology. 2013 Mar; 120 (3):528‑34.Cho BJ, Park KH. Topographic correlation between β-zone parapapillary atrophy and retinal nerve fiber layer defect. Ophthalmology. 2013 Mar; 120 (3):528‑34.Lee EJ, Kim TW, Weinreb RN. β-Zone parapapillary atrophy and the rate of retinal nerve fiber layer thinning in glaucoma. Invest Ophthalmol Vis Sci 2011 Jun 22; 52 (7):4422‑7.Lee EJ, Kim TW, Weinreb RN. β-Zone parapapillary atrophy and the rate of retinal nerve fiber layer thinning in glaucoma. Invest Ophthalmol Vis Sci 2011 Jun 22; 52 (7):4422‑7.Prata TS, De Moraes CG, Teng CC. Factors affecting rates of visual field progression in laucoma patients with optic disc hemorrhage. Ophthalmology 2010 Jan; 117 (1):24‑9.Prata TS, De Moraes CG, Teng CC. Factors affecting rates of visual field progression in laucoma patients with optic disc hemorrhage. Ophthalmology 2010 Jan; 117 (1):24‑9.See JL, Nicolela MT, Chauhan BC. Rates of neuroretinal rim and peripapillary atrophy area change: a comparative study of glaucoma patients and normal controls. Ophthalmology 2009; 116:840‑7.See JL, Nicolela MT, Chauhan BC. Rates of neuroretinal rim and peripapillary atrophy area change: a comparative study of glaucoma patients and normal controls. Ophthalmology 2009; 116:840‑7.Teng CC, De Moraes CG, Prata TS, et al. Beta-Zone parapapillary atrophy and the velocity of glaucoma progression. Ophthalmology 2010 May; 117 (5):909‑15.Teng CC, De Moraes CG, Prata TS, et al. Beta-Zone parapapillary atrophy and the velocity of glaucoma progression. Ophthalmology 2010 May; 117 (5):909‑15.Teng CC, De Moraes CG, Prata TS, et al. The region of largest β-zone parapapillary atrophy area predicts the location of most rapid visual field progression. Ophthalmology 1 Dec; 118 (12):2409‑13.Teng CC, De Moraes CG, Prata TS, et al. The region of largest β-zone parapapillary atrophy area predicts the location of most rapid visual field progression. Ophthalmology 1 Dec; 118 (12):2409‑13.Davitt BV, Wallace DK. Plus disease. Surv Ophthalmol 2009 Nov-Dec; 54 (6):663‑70.Davitt BV, Wallace DK. Plus disease. Surv Ophthalmol 2009 Nov-Dec; 54 (6):663‑70.

The authors declare that there are no conflicts of interest present.